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4. DO NOT USE THIS FORM TO REPORT VEHICLE ACCIDENTS OF ANY KIND.

   DIAL 9-1-1 FOR EMERGENCY SITUATIONS.

   Please use this form to report any chronic traffic safety issues observed in the City of Milpitas. You can report traffic safety concerns such as speeding, reckless driving, or general traffic safety situations. All complaints will be reviewed by the Milpitas Police Department-Traffic Safety Unit. Please be as specific as possible when providing the time, location, and description of the complaint.

6. First Name:
7. Last Name:
9. Daytime Phone Number:
10. Email Address:

12. Traffic Complaint Information

14. Date / Time of Incident:
    Date / Time of Incident:

    Date / Time of Incident:
15. Location of Incident:
17. Description of Incident:
19. Additional Information:
21. Would you like to be contacted?:

    1. Please contact me to discuss this traffic incident.
    2. Only contact me if additional information is required.
Leave This Blank:


23. Submit

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